Severe acute respiratory SARS-CoV-2 infection in dialysis patients in northern Italy: a single-centre experience

Abstract

Background Dialysis patients are considered at high risk for COVID-19 and the infection can easily spread in dialysis units. Methods We conducted an observational single-centre cohort study to describe clinical characteristics, treatments and outcomes of dialysis patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We tested patients who presented symptoms or had contact with a confirmed case. We enrolled 15 patients positive for SARS-CoV-2. Results We tested 37 of 306 dialysis patients. Patients with SARS-CoV-2 infection were older (mean age 75.96 ± 11.09 years) and all had comorbidities. At presentation, most had interstitial infiltrates on chest X-ray, three-quarters had leucopenia and none had respiratory insufficiency. During follow-up, there was an increase in serum C-reactive protein and interleukin-6. Eighty percent of patients received supplemental oxygen; none received non-invasive ventilation, one was intubated. Most patients (80%) were treated with oral hydroxychloroquine for a median time of 6.5 days [interquartile range (IQR) 5–14.5] and 40% received azithromycin; two patients received a short course of antivirals and one received a single dose of tocilizumab. Only two patients did not require hospitalization. Of the nine survivors, eight still tested positive for SARS-CoV-2 a median of 19 days (IQR 9.25–23) after diagnosis. Six patients died (case fatality rate 40%) a median of 5.5 days (IQR 1.75–9.75) after diagnosis. The main reported cause of death was respiratory failure related to COVID-19 (five patients). Conclusions We report a single-centre experience of SARS-CoV-2 infection in dialysis patients. The disease showed a high case fatality rate and most patients required hospitalization. Survivors show prolonged viral shedding.

Time on previous renal replacement therapy is associated with worse outcomes of COVID-19 in a regional cohort of kidney transplant and dialysis patients

“…First, in HD patients the risk of being SARS-CoV-2-positive and of developing COVID-19 was 5.3% and 4.1%, respectively (calculated as 14 or 11 cases/260 HD patients). This is identical to the findings of a similar Italian dialysis cohort [ 29 ] and also supported by data from Spain. [ 41 ] This incidence lies somewhat above the officially reported case-rate of 3.1% in the Heinsberg area's general population but below the 15.5% infection-rate established in the area's hotspot by proactive combinatorial PCR and serologic screening of ∼1000 persons in ∼400 households.…”

“…In support of this interaction, the Wuhan dialysis cohort also observed a substantially higher median dialysis age in the 2 individuals that died until analysis closure, [ 28 ] while 2 additional early-outcome cohorts with homogeneously brief dialysis histories were inherently underpowered to detect such an association. [ 19 , 29 ] Owing to their different focus (death rather than ARDS) and lack of completed outcomes, there are currently no further studies directly addressing the issue, neither in KTX (cohort sizes 15–144), [ 17 , 20 , 23 , 30 – 32 ] nor in dialysis patients (cohort sizes 32–154). [ 33 – 37 ] The recent elegant multicentric search for death-associated risk factors in 144 KTX patients by Cravedi, Riella and colleagues deserves special mentioning, since it detected a signal of significance for a lower baseline GFR.…”

Fabry disease and COVID-19: international expert recommendations for management based on real-world experience

“…However, wearing a mask after illness onset in the primary case was not significantly protective. Although PCR positivity does not mean patients are infectious, an additional consideration is that individuals with decreased kidney function may remain viremic for longer than other patients, with up to 90% of dialysis patients still PCR-positive a median of 19 days post-diagnosis [ 94 ]. Patient #16 in our series was PCR-positive 30 days post-diagnosis ( Table 3 ).…”

Long‐term effects of COVID‐19 in a patient on maintenance dialysis

“…3 In the city of Modena (Northern Italy), we recorded six fatal infections (mortality rate of 40%) among 280 patients on maintenance dialysis. 7 The clinical course of this concerning infectious disease appears unpredictable and associated with a variable fatality rate. The outcome of the disease relies on a complex interplay between the pathogenicity of the virus and the host immune response.…”

“…1 There is little information about the outcome of patients with chronic kidney disease. [2][3][4][5][6][7] Patients on renal replacement therapy are the most vulnerable for SARS-CoV-2 infection, as they are old and have a high burden of multiple comorbidities. We report clinical manifestation and outcome of COVID-19 in a patient on maintenance dialysis with long-term infection due to recurrent polymerase chain reaction (PCR) positivity and recrudescence of COVID-19 after clinical and laboratory resolution of the disease.…”